When seeking Charlotte, NC Health Insurance, we are confident agent David Bentley will be able to assist you in finding the correct plan for your current lifestyle. David will take the time to certain you understand what is covered in your policy and which network you are in. He is also available to meet with you at your convenience. Reach out to him today at 919-459-2683 or 855-ITS-BLUE (855-487-2583).
Some of the commonly asked questions related to Charlotte, NC health insurance are as follows:
- How Long Does it Take to Get My Blue Cross NC Health Insurance Card?
- Why Should You Choose an NC Health Insurance Agent/Broker Over Healthcare.gov
- Does Age or Being Male or Female Change the Price of Medicare in NC?
If you have any other questions related to signing up for health insurance or changing your current North Carolina health insurance plan, we look forward to hearing from you.
Blue Cross NC Health Insurance
Our team of healthcare insurance professionals can assist you with any questions you may have when it comes to Charlotte, NC health insurance plans. Having some of the most educated and experienced agents in the Charlotte area allows our clients to know exactly what the Blue Cross NC insurance plan covers. There should be no concerns as it pertains to what is covered in relation to a hospital visit, prescription drugs or annual check ups. David Bentley will go above and beyond to educate you and your family on the Blue Cross NC health insurance options. If you are wondering if the 2018 healthcare bill will affect Charlotte residents, call The Mair Agency now.
Charlotte, NC Growth
Charlotte, North Carolina is the largest city in the state and is an area in which the population has grown tremendously over the last two decades. In 1999, the population of Charlotte was 520,829. In 2016, the population was 842,051. The general Charlotte area population is around 2.5 million. We suspect this number will continue to grow as more and more business professionals and young families flock to the area with the high quality schools and fantastic job market.
The largest employers in Charlotte, NC are as follows:
- Carolinas HealthCare System
- Wells Fargo & Co.
- Wal-Mart Stores Inc.
- Bank of America Corp.
- American Airlines Group
- Charlotte-Mecklenburg Schools
- Novant Health
- City of Charlotte
- Daimler Trucks North America LLC
- Duke Energy Corp
- Food Lion LLC
- Harris Teeter
- North Carolina State Government
- U.S. Government
- AT&T North Carolina
- Cabarrus County Schools
- CaroMont Health Inc
- Compass Group
- Gaston County Schools
- Mecklenburg County
- Rowan-Salisbury Schools
- Target Stores
- Time Warner Cable
- U.S. Postal Service
- Union County Public Schools
- University of North Carolina at Charlotte
Relocating to Charlotte
We have a great deal of experience when it comes to relocating to Charlotte, North Carolina. Whether you are looking for a local credit union or bank, the best schools, a pest control company or the location of the local DMV, we can assist. Do not hesitate to reach out to us if you have any questions about moving to the area. We are also aware of the top retirement communities and the aging in place communities. If you are a senior looking to downsize into an apartment or are looking for the best places to retire in Charlotte, we can offer some advice.
If you are new to the area and are looking for temporary or self employed health insurance, make sure to contact The Mair Agency today. We can assist you in finding the right insurance policy to fit your needs.
If you happen to be retiring to the area or are looking for Medicare options, we have a great deal of experience in this subject matter. We have a team of health insurance professionals that can assist you with Medicare Part A and B or Medicare Supplements. We will work diligently to make certain you have the right Medicare plan.
Mecklenburg County Health Insurance
In Mecklenburg County, Blue Cross NC offers Blue Value, Blue Local with Carolinas HealthCare System. If you would like to learn more about the options that are available to you in Charlotte, North Carolina contact David Bentley today. He will go over all the options when it comes to Blue Cross Blue Shield of North Carolina. He will also be able to help you get a health insurance rate quote today.
Blue Cross NC Dental
When Charlotte area residents are choosing a health insurance plan, they often inquire about dental coverage or dental insurance. Rather than having to pay $200 for every cleaning at your local dentist, it might be worth it for you to add the Blue Cross NC Dental Plan to your healthcare coverage. Note that not every dental procedure is covered by insurance. Do not assume dental implants, dentures, tooth extractions or other types of oral surgery will be covered by dental insurance. That said, if you would like to better understand Blue Cross NC Dental Plan coverage in Charlotte, North Carolina, contact The Mair Agency today.
Health Insurance Lecture
Preferred Provider option, this is kind of a combination of an HMO and a POS, because some of your benefits might have just a co-pay. So for example, a preferred provider contract might look like in network, and that is again, with a PPO you have in network and out of network. In network, your preventative medicine is paid for. Your sick visits to the doctor, you have a $20 co-pay. Everything else, you have a $500 deductible and it pays 80-20. Out of network you have a $500 deductible and it pays 60-40. So again, it’s kind of a combination. If you’re in network you get a yearly exam and your office visits only have a co-pay. Everything else, might be a deductible with the 80-20 type thing.
So again, a preferred provider is your blended option, this is where they mix a managed health care plan with a point of service plan. So you have flexibility of in network and out of network. Obviously, you go out of network any time, you’re going to pay more but the interest company does pay something. So we have our three types, our HMO, which you have only in network, no out of network and you have co-pays. You have your POS where you have in network and out of network, you make your own choices, you have deductible and benefits. In network the benefits are higher than out of network.
You have a PPO and this is those two plans combined. So you could have some benefits that have a co-pay only and some benefits that require … You could have to have a primary care doctor, and you have some benefits in network that have a deductible 80-20 type thing. But you also have that out of network option, which gives you a deductible and reduced benefits. But the insurance company does still pay something. So again, the PPO is probably one of the most common because of the fact that it’s blended. Okay.
Consumer driven health plan. Basically, this is a PPO or a POS, okay? The difference is these have high deductibles, $5,000 dollars a year, $10,000 a year. They come with a medical savings plan. What your medical savings plan is you have a combination of three, you have in each our HRA, which is the health reimbursement account. When I worked at … I did a part time job when I worked at the bank, and it was very nice, I had a $2,000 deductible. The bank gave me what was kind of like a credit card, they gave me a car that was worth $500. So it’s kind of like a gift card, think of it as a gift card. They gave me a gift card of $500. So instead of me having to pay the full $2,000 deductible on my own, I have this $500 card from them.
So my first $500 worth of the services, I use that card. Then I still had to pay $1,500, then the insurance would kick in. So when you have to consumer-driven health plan obviously, the employers and the insurance companies know if you have to pay cash you’re going to think twice about going to the doctor so you might not get medical services. So with these high deductibles, the government has allowed you to have the health reimbursement account, which is what I had from that employer, or the employer can offer a flexible spending account, or there’s another name for the same thing.
One of them is the employer puts in a portion and one of them is strictly you. How those work, a flexible spending account, is I figure out ahead of time, well, I know that one of the kids is going to need to have braces. So I know that’s going to cost $2,000. So I’m going to be paying $2,000 this year for medical bills, I know it. Plus they’re going to have to have two physicals because they have to go to school, and they have to have their physicals and their shots before they go to school. So those are probably going to cost me about 200 each. So I know I’m going to have $2,400 worth of medical bills that I’m going to have to pay.
So what I’m going to do is I’m going to have my employer take some money out of my paycheck pretax, so before taxes, take it, and put it in an account. Then I can use that account to pay for medical bills. The downside to flexible spending accounts, many of them, if you don’t use the money it just goes to your employer and you lose it. So you need to be very aware of how a flexible spending account works if you get into one because you need to be very good at calculating what your medical expenses are going to be. Because again, if you don’t use that money in the calendar year, it goes to your employer. So again be very aware on those, but know that when you have a high deductible usually there is a flexible spending or health reimbursement account type thing.
There are three major types of medical insurance payers. So when we’re talking about payers, which are insurance companies basically, you have private payers, which are your commercial insurance companies, that’s your Blue Cross, your Aetna, Cigna, your UnitedHealthCare. Those are your private payers. Then you have self-funded health plans. Most of these are managed by an insurance company but let’s just say, for example, you work for General Motors. Well obviously, General Motors has how many thousands of employees. Instead of paying an insurance company premiums every month, what they’ve decided is they put a large amount of money into a fund, you still have premiums that you have to pay into that fund, but General Motors takes responsibility for making sure that all of the money for the claims is there.
General Motors takes the responsibility versus Blue Cross. General Motors might have Blue Cross process the claims because Blue Cross has the computer software to process the claims. The reason for self-fund and self-insurance is because those employers like General Motors have more flexibility as to choosing what benefits that their employees have and they can usually offer a lower cost to their employees. However, again, you have to think of it it’s an insurance, the patient still has insurance and you have to bill an insurance company to get paid. So really, from the payer side, from you being paid, it really doesn’t, you don’t really care if it’s a private payer or a self-funded or a government sponsored health care. All you care about is where you need to bill the claim and how much you’re going to get paid, okay. So what the benefits are.
Your government sponsor are your Medicare, your Medicaid, your Tri-Care, and your CHAMPVA. The Patient Protection and Affordable Care Act was signed into law in 2010 and it’s facing until 2014. Obviously, this is our big thing, it’s sometimes called Obamacare, okay. This is basically what the Health Care Reform Act, it was also called Obamacare so you’ve heard it one way or the other. It changed the guidelines for preexisting conditions, I talked a little bit about that preexisting condition, so again, it changed the guidelines for that. Now, young adults can remain on the parents’ policy until 26, they had to be going to college full time and covered until 21 to 22 depending on the insurance policy, now it’s until 26.
Payers cannot impose lifetime financial benefit limits, which means an insurance company says we will only pay up to half a million dollars versus that out of pocket. Now this is different, the out of pocket is still there. Okay? The patient only has to pay an out of pocket of so much. However, insurance companies used to say we would only pay up to half a million dollars or a million dollars and then you have no insurance at all. They can no longer impose those financial benefit limits. 80% of every dollar that an insurance company receives from you in the way of premiums must be spent on health care. If it’s not, you’ll get a refund check at the end of the year. Okay.
Some of you may have the experience that, I know I’ve experienced that where I’ve gotten a small refund. It hasn’t been much but again, they have to spend 80% of what they get in the way premiums on healthcare. They only have 20% of what they get in their premiums to manage their operations. Preventative services for women are included. Prior to this, they didn’t necessarily have to be included and that was your mammograms, okay, and your pap smears and stuff like that. So the preventative services for women are now they must be included in the insurance company benefits. Many future benefits to patients including major changes to Medicare and Medicaid. Obviously, there are changes always to Medicare, and Medicaid is your low income, no insurance state-run plan. We’ll get more into that you later chapters.
Medical insurance specialist, it’s going to be you. Staff member who handles your billing, checks insurance, and process payment, and some form of combination whether you’re a coder, a biller, a receptionist. Don’t get stuck as you’re in the medical field in titles because I’ve had so many titles but basically done the same job. Look at what the job entails versus the title. Titles are just, you know, they’re whatever. Everybody calls something something different. I know when I managed at the hospital there used to be the admissions department, the outpatient registration department, and the billing department.
Well, somebody got this great idea they combined all of them into one department and called them Patient Service Representatives. You still did admitting, you still did outpatient registration, or you still did billing, but you are now called the patient service representative. So again, it’s a bit semantics, just a title. To complete your duties, medical insurance specialist follow a 10-step medical billing cycle. These are the series of steps leading to maximum, appropriate, and timely payment.
Step one, pre-register. Any time you’ve gone to a new physician’s office you call and make an appointment, they get information. That’s a pre-registration. You need to establish financial responsibility because prior to the patient coming in you need to know who’s paying the bill. Is it the patient or is it the insurance company? If it’s insurance company, how much does the insurance company pay and how much does the patient pay? The more you have upfront information, the easier it is for the patient and for you because you notify the patient ahead of time.
Today’s visit, you know, for this visit your insurance company is only going to pay 50%, you are going to have to pay the other 50% so please bring $250 with you. When the patient comes, you check in the patient. After the patient is there you review your coding compliance. So a medical coder will have specialized training to handle the diagnostic and procedural coding, you will have that experience and training. The patient’s primary illness is assigned a diagnosis code. The diagnosis code, why did the patient walk through the door? That’s what the diagnosis code code is, why did the patient walk through the door? And we’ll get more into that later.
You review your coding compliance. So each procedure we’re talking about that fee for service, these are the services, the services have a procedure code. So an office visit level three is a 99213, chest x-ray one view, 71010, urinalysis dipstick is 81000. Office visit for a new patient level is 99203. So again, each fee for service, each service has a procedure code. Your transactions are entered in a patient ledger, which is the record of the patient’s financial transactions. This is on your practice management program.
Now you need to review your coding compliance. This means that you satisfy official requirements, this means you aren’t billing for services not rendered, this means you are billing for things that are medically necessary and that you are only performing services that are medically necessary, that’s compliance. Now you check the patient out, and now you prepare and transmit your claims. You must monitor payer adjudication. Adjudication is the word insurance companies use for processing the claim. So when they process the claim, they have adjudicated the claim. They can either deny it, pay it, or send it for medical review.
Your accounts receivable, these are the monies owed. Adjudication is a process of processing the claims. If you send a hundred claims to the insurance company, about 96 will get there and we’ll get it to all that later. You need to follow up on those four claims that didn’t get there, then out of those 96 claims, 10 of them may be denied. You need to follow up on those 10 that are denied. So that’s your monitoring your payer adjudication. Then the ones that are paid, you need to make sure you’re being paid according to your contract, according to the fee schedule, okay.
Step nine, generate patient statement. Statements because obviously there are going to be things you’re going to be billing the patients for at the end, and then follow up on payments and collections. How do you achieve success? Being professional. This is acting for the good of the public and for the medical practice. Medical ethics are to your standards of behavior requiring truthfulness, honesty, and integrity.
An etiquette is made up of these standards of professional behavior. Obviously, you’re not going to be in love with every single one of the patients that are in front of you, but however, and you may not believe in their values, you may not believe in their lifestyle. However, you need to be professional at all time, you need to have manners at all times. You need to be honest and have integrity. This is what is expected in the practice and this is how you will succeed.
So what are your requirements for success? Obviously, knowledge of medical language and coding, which you’re getting in this program. Good communication skills, attention to detail, flexibility, you’re going to multi-task constantly. You have to have that flexibility. Health information technology skills, basically, just being familiar with and comfortable in software. Putting, entering information in software, moving within from one screen to another screen. Honesty and integrity and being part of a team, because you have to rely on that receptionist for getting certain information, on that medical assistant, that nurse, and that physician.
I don’t care if you like these people or not, but from 8:00 to 5:00, Monday through Friday, you are a good team player and you keep your mouth shut and you like this receptionist and this medical assistant. Because if you don’t, they can ruin your job because they can give the improper information or they can put wrong information in the system. So it’s very important that you are part of a team and work together with the people within your practice. Otherwise, you will fail and you will hurt the practice and you will probably wind up losing your job, too.
Attributes, your appearance, you must have a good professional appearance. Attendance, you have to be there. The bills have to go out daily for the money to come in daily in order to get paychecks. If you are not there, the work isn’t getting done because usually for a medical bill or encoder, nobody else is doing your job when you leave. When a receptionist is sick, guess what? The medical biller or encoder has to cover the receptionist usually. Or the medical assistant or the nurse has to cover reception. Their jobs aren’t getting done, so you have to make sure you’re there and give good attendance because you have to get your job done and those claims have to go out for the money to come.
Initiative, you have to give a 110%. You can’t just come in and do, “Oh, I’m just going to do this and that’s it.” You need to give a 110%, you need to be creative, you need to use your resources. Courtesy, obviously manners are huge. Continuing education requirements for certification. You are going to be certified, you’re going to get continuing education credits. You have to stay involved, you have to stay up on what’s changing in the medical field. It’s important to stay up on that because, you know what, if you want to succeed in the medical field and go further, you need to do this.
Certifications, recognition of a superior level of skill by the official professional organization. It provides evidence to prospective employers that the applicant has demonstrated superior level. Again, we’re talked about titles. Let me give you a prime example. I took over an office for a group of emergency room physicians. I had a girl there and I said, “What is your job?” She says, “I do collections.” I said, “Great. What do you do?” She says, “I send out statements every month.” Well, that’s not collections. Sending out a statement every month to a patient is not collections. That’s all she did and she thought she did collections because her title was collections.
So a job title can’t necessarily say that you have these skills, certification can. I’m a certified professional biller, a certified professional coder. These certifications say I actually do have that knowledge and I actually do know how to do it. Whereas just a job title, doesn’t always cover everything.
So let’s talk about chapter two, electronic health records, HIPAA and HITECH. Patient’s medical record obviously contains facts, finding, and observations about the patient’s health. Documentation, if it isn’t documented in the medical field, it didn’t happen. All of your payment is dependent on documentation. So the documentation must be consistent. Medical standards of care state specific performance measures. Medical records in documentation are your legal document, they help physicians make accurate diagnoses.